A trial of transcutaneous electrical nerve stimulation (TENS) of at least 30 days may be considered medically necessary to establish efficacy for the management of refractory chronic pain (eg, chronic musculoskeletal pain or neuropathic pain) that causes significant disruption of function when the following conditions have been met:
The pain is unresponsive to at least 3 months of conservative medical therapy; and
The trial is monitored by a physician.
Continued use of TENS may be considered medically necessary for treatment of refractory chronic pain (eg, chronic musculoskeletal or neuropathic pain) that causes significant disruption of function when the following conditions have been met:
Efficacy has been demonstrated in an initial therapeutic trial (see Policy Guidelines section); and
Compliance has been demonstrated in the therapeutic trial with the device used on a regular basis (eg, daily or near daily use) throughout the trial period.
TENS is considered investigational for the management of acute pain (eg, postoperative or during labor and delivery).
TENS is considered investigational for the prevention or treatment of migraine headache.
TENS is considered investigational for the management of essential tremor.
TENS is considered investigational for the management of attention deficit hyperactivity disorder.
The use of TENS for any other condition, including but not limited to the treatment of dementia is considered investigational.
